HIV continues to spread among Black men who have sex with men (MSM), but few interventions target high- risk Black men who have sex with men and women (MSM/W). Black MSM/W with histories of childhood sexual abuse (CSA) may be an especially vulnerable population for: a) high-risk sexual behaviors;b) negative psychological sequelae (e.g., depressive or posttraumatic stress disorder (PTSD) symptoms);and c) neurobiological abnormalities in cardiovascular, neuroendocrine and/or immune systems (e.g. cortisol and norepinephrine), and HIV/AIDS progression. This 3-year R34 pilot study, An HIV Intervention for Black Men at Risk, builds on the evidenced-base NIMH-funded Women's Health Intervention and a state funded HIV risk reduction pilot, The Men's Sexual Risk Reduction Project, for HIV positive gay-identifying African American and Latino MSM with histories of sexual abuse. This study will consist of three phases: Phase I. The Formative Phase will include three 90-minute focus groups to identify feasibility issues and factors pertinent to recruiting and conducting a psychosocial intervention such as perceptions of masculinity and gender roles. Two groups will include HIV positive Black MSM/W with histories of CSA and the third group with community leaders that work with non-gay identifying Black MSM/W. In Phase II-The Pilot, we will modify the existing manualized Men's Sexual Risk Reduction intervention and pilot it on 8-10 non-gay identifying HIV positive Black MSM/W with histories of CSA. In Phase Three-The Intervention, guided by the Social Learning Theory, the Ecological Model, and the concept of allostatic load, a composite of the cumulative effects of stress on biological systems including psychoneuroimmonologic markers, we will test the 6-session Enhanced Sexual Health Intervention for Men (ES-HIM) on 88 non-gay identifying HIV positive Black MSM/W with histories of CSA. The outcomes are to reduce high-risk sexual behavior (i.e., unprotected anal and vaginal sex) and negative psychological symptoms of depression and PTSD. Links between these outcomes and biomarkers of stress will be explored. Randomization to either the ES-HIM or a health promotion (HP) control group will occur with participants assessed at baseline, post, 3- and 6-months. A full spectrum of univariate and multivariate approaches will be used to evaluate the efficacy of randomization at baseline, to test for group differences at baseline as a function of CSA severity, as well as to test for treatment effect differences over time on the primary outcomes of interest. The findings from this pilot study will be used in the application for a larger NIMH R01 intervention. The Enhanced Sexual Health Intervention for Men (ES-HIM) is a biopsychosocial HIV risk reduction intervention. Its aims are to decrease high-risk sexual behaviors and depressive and PTSD symptoms among HIV-positive non-gay identifying Black men who have sex with men and women and who have a history of childhood sexual abuse. Besides improving mental health and helping to decrease the risk of HIV re-infection and transmission among these men and their male and female partners, ES-HIM explores the relationship between these outcomes and biomarkers of stress. Understanding these associations may be important in improving mental and physical health of this vulnerable population of men.